Provider Demographics
NPI:1073592291
Name:LO, NELSON (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3038
Mailing Address - Country:US
Mailing Address - Phone:712-792-0702
Mailing Address - Fax:712-792-0704
Practice Address - Street 1:405 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3047
Practice Address - Country:US
Practice Address - Phone:712-792-0702
Practice Address - Fax:712-792-0704
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32707207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0183582Medicaid
IA0183582Medicaid
IA48051Medicare ID - Type Unspecified